Sleeping, Breathing, and Quality of Life: A Healthy People ... · Sleeping, Breathing, and Quality of Life: A Healthy People 2020 Progress Review ... Told if asthma is work -related

Sleeping, Breathing, and Quality of Life: A Healthy People 2020 Progress Review

December 5, 2013

Howard K. Koh, MD, MPH Assistant Secretary for Health

U.S. Department of Health and Human Services

Overview and Presenters

Chair ■ Howard K. Koh, MD, MPH, Assistant Secretary for Health U.S. Department of Health and Human Services

Data Presentation ■ Irma Arispe, PhD, Associate Director National Center for Health Statistics Centers for Disease Control and Prevention

Research and Program presentation ■ Gary Gibbons, MD, Director

National Heart, Lung and Blood Institute, NIH

■ Vikas Kapil, DO, MPH, FACOEM, Acting Deputy Director Chief Medical Officer, National Center for Environmental Health

Agency for Toxic Substances and Disease Registry, CDC

Community Highlight ■ Karen Meyerson, FNP-C, AE-C Manager, Asthma Network of West Michigan

Healthy People 2020 Evolves

1979 Smallpox Eradicated

1982 AIDS is Infectious

■ Chronic Lower Respiratory Disease (CLRD) is the third leading cause of death

– Asthma - $53.42 billion (2011) Prevalence: 25.6 million people or 8.3% (2012)

• 6.8 million children (9.3%) • 18.7 million adults (8.0%)

– Chronic Obstructive Pulmonary Disease (COPD) - $49.9 billion (2010) Prevalence: 11.3 million adults or 4.8 % (2012)

• Includes emphysema and chronic bronchitis, older adults

Overview: Respiratory Diseases

SOURCE: National Health Interview Survey (NHIS), CDC/NCHS.

■ Asthma was responsible for (2010): – 14.2 million physician office visits – 1.8 million emergency department visits – 439,000 hospitalizations – 3,404 deaths

■ COPD was responsible for (2010):

– 1.2 million physician office visits – 1.8 million emergency department visits – 700,480 hospitalizations – 133,660 deaths

Overview: Respiratory Diseases

SOURCES: National Vital Statistics System—Mortality (NVSS-M), National Hospital Discharge Survey (NHDS), National Hospital Ambulatory Medical Care Survey (NHAMCS), National Ambulatory Medical Care Survey (NAMCS)

Overview: Sleep Health

■ Sleep Deficiency and Causes: – Lifestyle factors – Occupational factors – Sleep disorders

■ Insufficient sleep and sleep disorders are associated with: – Risk, management, and outcome of chronic disease Cardiovascular disease Diabetes Obesity Depression

– Motor vehicle crashes and machinery-related errors

Healthy People 2020 Progress Review: Sleeping, Breathing, and Quality of Life

December 5, 2013

Irma Arispe, PhD Associate Director, National Center for Health Statistics

Centers for Disease Control and Prevention

Presentation Outline

■ Respiratory Diseases – Asthma – Chronic Obstructive Pulmonary Disease

(COPD)

■ Sleep Health

10

11

Burden of Respiratory Diseases, 2010

SOURCES: National Vital Statistics System—Mortality (NVSS-M), National Hospital Discharge Survey (NHDS), National Hospital Ambulatory Medical Care Survey (NHAMCS), National Ambulatory Medical Care Survey (NAMCS), and National Health Interview Survey (NHIS), CDC/NCHS.

NOTES: Data are for all ages except for COPD prevalence which is among adults aged 18 years and over. Deaths are based on an underlying cause of asthma (ICD-10 codes J45–J46) or COPD (ICD-10 codes J40–J44). Hospital discharges, emergency department visits, and office visits are based on a principal diagnosis of asthma (ICD-9-CM code 493) or COPD (ICD-9-CM code 490-492, 496). Asthma prevalence is defined as the proportion of persons with current asthma. COPD prevalence is defined as proportion of adults who have ever been diagnosed with emphysema or who were diagnosed with chronic bronchitis in the last 12 months.

Asthma Prevalence, 1980–2012

0

2

4

6

8

10Percent


Asthma 12-month period prevalence

Current asthma prevalence 1997 NHIS Redesign

12

NOTES: Asthma period prevalence is the proportion of persons with asthma in the previous 12 months; current asthma prevalence is the proportion of persons with asthma at the time of interview. After the redesign, a medical diagnosis of asthma was required and proxy reporting for adults was eliminated.

Current Asthma Prevalence, 2012

0

5

10

15

20

25

Male Female Male Female

Percent

NOTES: I = 95% confidence interval. Respondents were asked to select one or more races. The race categories black and white are for persons who reported only one racial group and exclude persons of Hispanic origin. Persons identified as Hispanic can be of any race. SOURCE: National Health Interview Survey (NHIS), CDC/NCHS.

Adults 18+ years Children <18 years

13

Total Black White Hispanic

0

5

10

15

20

25

30

35

All White,non-Hispanic

Black,non-Hispanic

Mexican Puerto Rican

Percent

NOTES: I = 95% confidence interval. Data are age adjusted to the 2000 standard population. Income groups are defined based on the ratio of family income to poverty threshold: nonpoor 200%+, near poor 100-199%, poor <100%. Respondents were asked to select one or more races. The categories black and white are for persons who reported only one racial group and exclude persons of Hispanic origin. Persons identified as Mexican or Puerto Rican may be of any race. •

Current Asthma Prevalence, 2010–2012

SOURCE: National Health Interview Survey (NHIS), CDC/NCHS. 14

Nonpoor Near Poor Poor

Asthma Hospitalizations, 2010

Objs. RD-2.1, 2.2, 2.3 Decrease desired

15 SOURCE: National Hospital Discharge Survey (NHDS), CDC/NCHS.

NOTES: I = 95% confidence interval. Data are for hospital discharges with a principal diagnosis of asthma (ICD-9-CM code 493). Data, except those for children under age 5 years, are age adjusted to the 2000 standard population. Healthy People 2020 objectives RD-2.1, 2.2, and 2.3 track asthma hospitalizations separately for ages <5, 5-64, and 65+, respectively, while the data displayed here by sex and race are for all ages. The race categories black and white include persons of Hispanic or non-Hispanic origin for whom only one racial group was recorded. * Data are unreliable.

Asthma Deaths, 1999–2010

0

10

20

30

40

50

60

70

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

35-64 years

65+ years

NOTES: Data are for deaths with an underlying cause of asthma (ICD-10 codes J45–J46). • SOURCE: National Vital Statistics System—Mortality (NVSS-M), CDC/NCHS.

<35 years

Rate per million

16 Obj. RD-1.1, 1.2, 1.3

Decrease desired

HP2020 Target: 21.5

HP2020 Target: 4.9

No HP2020 Target

0

10

20

30

40

Total Female Male Black,non-Hispanic

White,non-Hispanic

Asian/PacificIslander

Am Indian/AK Native

Hispanic/Latino

Rate per million

Asthma Deaths

NOTES: I = 95% confidence interval. Data are for deaths with an underlying cause of asthma (ICD-10 codes J45–J46). HP2020 objectives RD-1.1, 1.2, and 1.3 track asthma deaths separately for ages <35, 35-64, and 65+, respectively, while the data displayed here for the total and by sex and race are for all ages. Prior to 2003, only one race could be recorded; recording more than one race was not an option. Beginning in 2003 multiple-race data were reported by some states; multiple-race data were bridged to the single-race categories for comparability. Persons of Hispanic origin may be of any race.

17 SOURCE: National Vital Statistics System—Mortality (NVSS-M), CDC/NCHS.

1999 2010

Appropriate Asthma Care, 2008

18

0 10 20 30 40 50 60 70 80 90 100Percent

HP2020 Target: 36.8%





No HP2020 Target Told how to use inhaler

No overuse of rescue inhaler

Taught to recognize and respond to

symptoms

Advice re: exposure to environmental triggers

Received written asthma plan

Told if asthma is work-related (2010)

Objs. RD-7.1 through 7.5, 7.8 Increase desired

NOTES: I = 95% confidence interval. Data are for persons with current asthma who received the specified care from a health care provider, and are age adjusted to the 2000 standard population. SOURCE: National Health Interview Survey (NHIS), CDC/NCHS.

0

5

10

15

20

Total Total < 100 100–199 200–399 400–599 600+

Percent

Activity Limitations due to Asthma Adults 18+ Years, 2008–2012

SOURCE: National Health Interview Survey (NHIS), CDC/NCHS 19

NOTES: I = 95% confidence interval. Data are for adults aged 18 years and over with current asthma who experienced activity limitations due to lung or breathing problems, and are age adjusted to the 2000 standard population. * Data are unreliable. Obj. RD-4

Decrease desired


Family Income (Percent Poverty Threshold)

2008 2012

*

Burden of Respiratory Diseases, 2010

20 SOURCES: National Vital Statistics System—Mortality (NVSS-M), National Hospital Discharge Survey (NHDS), National Hospital Ambulatory Medical Care Survey (NHAMCS), National Ambulatory Medical Care Survey (NAMCS), and National Health Interview Survey (NHIS), CDC/NCHS.

NOTES: Data are for all ages except for COPD prevalence which is among adults aged 18 and over. Deaths are based on an underlying cause of asthma (ICD-10 codes J45–J46) or COPD (ICD-10 codes J40–J44). Hospital discharges, emergency department visits, and office visits are based on a principal diagnosis of asthma (ICD-9-CM code 493) or COPD (ICD-9-CM code 490-492, 496). Asthma prevalence is defined as the proportion of persons with current asthma. COPD prevalence is defined as proportion of adults who have ever been diagnosed with emphysema or who were diagnosed with chronic bronchitis in the last 12 months.

COPD Prevalence, Adults 45+ Years, 2012

NOTES: Data are for adults aged 45 years and over who have ever been diagnosed with COPD, emphysema, or chronic bronchitis, and are age adjusted to the 2000 standard population. State data from the BRFSS may not be comparable to the national data from the NHIS.

SOURCE: Behavioral Risk Factor Surveillance System (BRFSS), CDC/PHSPO. 21

COPD Prevalence, 1997–2012

0

2

4

6

8

10

12

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

65+ years

45-64 years

Percent

18-44 years


NOTES: Data are for adults who have ever been diagnosed with emphysema or who were diagnosed with chronic bronchitis in the last 12 months.

22

0

5

10

15

20

All White,non-Hispanic

Black,non-Hispanic

Mexican Puerto Rican

Percent Nonpoor Near Poor Poor

NOTES: I = 95% confidence interval. Data are for adults aged 45 years and over who have ever been diagnosed with emphysema or who were diagnosed with chronic bronchitis in the last 12 months, and are age adjusted to the 2000 standard population. Income groups are defined based on the ratio of family income to poverty threshold: nonpoor 200%+, near poor 100-199%, poor <100%. Respondents were asked to select one or more races. The categories black and white are for persons who reported only one racial group and exclude persons of Hispanic origin. Persons identified as Mexican or Puerto Rican may be of any race. •

COPD Prevalence, Adults 45+ Years, 2010–2012

SOURCE: National Health Interview Survey (NHIS), CDC/NCHS. 23

0 15 30 45 60 75 90 105 120 135 150

Total

Female

Male

Black

White

45-64 years

65+ years

Rate per 10,000

COPD Hospitalizations, Adults 45+ Years, 2010

Obj. RD-11 Decrease desired



NOTES: I = 95% confidence interval. Data are for hospital discharges with a principal diagnosis of COPD (ICD-9-CM code 490-492, 496) among adults aged 45 years and over. Data, except those by age, are age adjusted to the 2000 standard population. The race categories black and white include persons of Hispanic or non-Hispanic origin for whom only one racial group was recorded.

0 50 100 150 200 250 300

Total

MaleFemale

White, non-HispanicAm Indian/AK nativeBlack, non-Hispanic

Hispanic/LatinoAsian/Pacific Islander

45-54 years55-64 years

65+ years

Rate per 100,000

COPD Deaths, Adults 45+ Years, 2010

HP2020 Target: 102.6


25 SOURCE: National Vital Statistics System—Mortality (NVSS-M), CDC/NCHS.

NOTES: I = 95% confidence interval. Data are for deaths with an underlying cause of COPD (ICD-10 codes J40–J44) among adults aged 45 years and over and are age adjusted to the 2000 standard population. Data by age are not age adjusted, and, therefore, the target does not apply to data by age. Multiple-race data were reported by some states; multiple-race data were bridged to the single-race categories for comparability. Persons of Hispanic origin may be of any race.

Activity Limitations due to COPD Adults 45+ Years, 2012

0

10

20

30

40

50

Total < 100 100–199 200–399 400–599 600+Family Income (Percent Poverty Threshold)

26

Percent



NOTES: I = 95% confidence interval. Data are for adults aged 45 years and over with COPD who experienced activity limitations due to lung or breathing problems, and are age adjusted to the 2000 standard population. * Data are unreliable. SOURCE: National Health Interview Survey (NHIS), CDC/NCHS.

*

Presentation Outline

■ Respiratory Diseases – Asthma – Chronic Obstructive Pulmonary Disease

(COPD)

■ Sleep Health

27

Sleep Health: Public Health Impact

■ 50–70 million people experience chronic sleep and wakefulness disorders.

■ Sleep disorders account for approximately $16 billion dollars in annual medical costs, in addition to costs for lost productivity.

■ Physician office visits (2010): – Sleep apnea* – 2.7 million – Insomnia – 5.8 million

SOURCES: Institute of Medicine. Sleep disorders and sleep deprivation: an unmet public health problem. Washington, DC: The National Academies Press; 2006. National Ambulatory Medical Care Survey (NAMCS), CDC/NCHS.

NOTES: * Sleep apnea is a disorder with one or more pauses in breathing or shallow breaths during sleep.

28

0 10 20 30 40

Total

FemaleMale

White, non-HispanicBlack, non-Hispanic

Mexican American

20-24 years25-44 years45-64 years

65+ years

Percent

Persons With Sleep Apnea Symptoms who Seek Medical Care, Adults 20+, 2005–2008

HP2020 Target: 28%

29 SOURCE: National Health and Nutrition Examination Survey (NHANES), CDC/NCHS. Obj. SH-1

Increase desired

NOTES: I = 95% confidence interval. Data are for adults aged 20 years and over who (snore 5 or more nights per week) OR (snort, gasp, or stop breathing 5 or more nights per week) OR (feel excessively sleepy during the day 16-30 times per month AND usually sleep 7 or more hours per night) who have told a health professional that they have trouble sleeping. Data are age adjusted to the 2000 standard population. Data by age are not age adjusted, and, therefore, the target does not apply to data by age. Respondents were asked to select one or more race categories. The categories black and white are for persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican origin may be any race.

0

1

2

3

4

2005 2006 2007 2008 2009 2010 2011

Crashes Involving Drowsy Drivers, 2005–2011

HP2020 Baseline

HP2020 Target: 2.1

SOURCE: General Estimates System (GES), DOT/NHTSA.

NOTES: Data are for vehicular crashes per 100 million miles traveled due to drowsy driving. General Estimates System data are from a nationally representative sample of police-reported motor vehicle crashes. To be included, the crash must involve a motor vehicle traveling on a traffic way and result in property damage, injury, or death.

Rate per 100 million vehicle miles traveled

Obj. SH-2 Decrease desired

30

0 20 40 60 80 100

Total

MaleFemale

18-24 years25-44 years45-64 years

65+ years

Hispanic or LatinoWhite, non-Hispanic

AsianAm. Indian/AK Native

Black, non-HispanicTwo or more races

Nat. Hawaiian or Pacific Isl.

Percent

Sufficient Sleep, Adults, 2012



Obj. SH-4 Increase desired

31

NOTES: I = 95% confidence interval. Data are for adults aged 18 years and over who get sufficient sleep (defined as ≥ 8 hours for those aged 18 to 21 years and ≥ 7 hours for those aged 22 years and over) on average during a 24-hour period. Respondents were asked to select one or more races. Data for the single race categories are for persons who reported only one racial group. Persons of Hispanic origin may be any race.

0 10 20 30 40 50

Total

FemaleMale

9th grade10th grade11th grade12th grade

Am. Indian/AK NativeWhite, non-Hispanic

Hispanic or LatinoNat. Hawaiian or Pacific Isl.

Two or more racesBlack, non-Hispanic

Asian

Percent

Sufficient Sleep, High School Students, 2011


SOURCE: Youth Risk Behavior Surveillance System (YRBSS), CDC/NCHHSTP. Obj. SH-3

Increase desired

32

NOTES: I = 95% confidence interval. Data are for students in grades 9–12 who report getting 8 or more hours of sleep on an average school night. Respondents were asked to select one or more races. The single race categories listed include persons who reported only one racial group. Persons of Hispanic origin may be of any race.

Key Takeaways

■ Asthma – Despite increasing prevalence, deaths have declined while

ED visits and hospitalizations have remained stable. – Age, sex, race and income disparities persist.

■ COPD – Prevalence is higher for older age groups and lower income

groups. – Disparities persist in hospitalizations and deaths by age and

race. – Death rates are highest among the non-Hispanic white

population.

■ Sleep Health – Disparities exist by sex, race, and age. – Most students in grades 11 and 12 do not get sufficient

sleep.

33

APPENDIX

34

Note: The information contained within these slides provides additional details to supplement the webinar material.

RD-1.1 Asthma deaths: <35 years RD-1.2 Asthma deaths: 35–64 years RD-1.3 Asthma deaths: 65+ years RD–2.1 Asthma hospitalizations: <5 years RD-2.2 Asthma hospitalizations: 5-64 years RD-2.3 Asthma hospitalizations: 65+ years RD-3.1 Asthma emergency department visits: <5 years RD-3.2 Asthma emergency department visits: 5-64 years RD-3.3 Asthma emergency department visits: 65+ years RD-4 Activity limitations among persons with asthma RD-5.1 Children with asthma who miss school days RD-5.2 Adults with asthma who miss work days RD-6 Patient education among persons with asthma RD-7.1 Persons with asthma receiving written asthma plans from health care providers RD-7.2 Persons with asthma receiving proper use instructions with prescribed inhalers

RD-7.3 Persons with asthma receiving education on early signs, symptoms, and responses to asthma episodes RD-7.4 Persons with asthma who do not use more than 1 beta agonist inhalation canister per month RD-7.5 Persons with asthma receiving advice from health professionals in reducing exposure to environmental risk factors RD-7.6 Persons with asthma who have had at least one routine follow-up visit in the past year RD-7.7 Persons with asthma whose doctor assessed their asthma control in the past year RD-7.8 Persons with asthma whose doctor assessed whether their asthma was work related RD-8 State comprehensive asthma surveillance systems RD-9 Activity limitations among persons with COPD RD-10 COPD deaths RD-11 COPD hospitalizations RD-12 COPD emergency department visits RD-13 COPD diagnosis among adults with underlying obstructive lung disease

Objective Status: Respiratory Diseases Target met Improving Little/No change Getting worse Baseline only Developmental

35

4% (n=1)

15% (n=4)

26% (n=7)

11% (n=3)

33% (n=9)

11% (n=3)

Total number of objectives: 27

Target met

Improving

Little/No change

Getting worse

Baseline only

Developmental

Current HP2020 Objective Status: Respiratory Diseases

Objective Status: Sleep Health

Target met Improving Little/No change Getting worse Baseline only 37

SH-1 Adults with symptoms of obstructive sleep apnea SH-2 Motor vehicle crashes involving drowsy driving SH-3 Students getting sufficient sleep on school nights SH-4 Adults getting sufficient sleep per night

Asthma Health Care Encounter Rates 2001–2009

0

20

40

60

80

100

HospitalEmergency departmentHospital outpatient deptPhysician office

Rate per 100 persons with asthma

SOURCE: National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey, National Hospital Discharge Survey, CDC/NCHS

NOTES: Data are for health care encounters with a principal diagnosis of asthma (ICD-9-CM code 493).

0

30

60

90

120

150

180

<5 5-64 65+Age (years)

Rate per 10,000

Asthma Emergency Department Visits

NOTES: I = 95% confidence interval. Data are for visits to an emergency department with a first-listed diagnosis of asthma (ICD-9-CM code 493). SOURCE: National Hospital Ambulatory Medical Care Survey (NHAMCS), CDC/NCHS.

HP2020 Target: 95.6

HP2020 Target: 49.7

HP2020 Target: 15.8

Obj. RD-3.1, 3.2, 3.3 Decrease desired

Under 5 years, 15%

5-64

years, 78%

65 years and over,

6%

Number of Asthma ED Visits, 2008-10

39

1995-97 2008-10

0

20

40

60

80

<5 5-64 65+Age (years)

1998 2010

Rate per 10,000

Asthma Hospitalizations by Age

NOTES: I = 95% confidence interval. Data are for hospital discharges with a principal diagnosis of asthma (ICD-9-CM code 493). Data, except those among children aged under 5 years, are age adjusted to the 2000 standard population.

HP2020 Target: 18.1

HP2020 Target: 8.6 HP2020 Target: 20.3

Obj. RD-2.1, 2.2, 2.3 Decrease desired

Under 5 years, 16%

5-64

years, 60%

65 years and over,

23%

Number of Asthma Hospitalizations, 2010


0

5

10

15

20

25

Total White, non-Hispanic Black, non-Hispanic Hispanic or Latino

2003 2008

Asthma Patient Education


NOTES: I = 95% confidence interval. Data are for the proportion of persons with current asthma who have ever taken a course or class on how to manage their asthma, and are age adjusted to the 2000 standard population. Respondents were asked to select one or more races. The categories black and white include persons who reported only one racial group. Persons of Hispanic origin may be of any race. Obj. RD-6

Increase desired

Percent

41


0

200

400

600

800

1000

Total <45 45-64 65-74 75+

Rate per 1,000

Age (years)

COPD Physician Office Visits, 2008-2010

SOURCE: National Ambulatory Medical Care Survey (NAMCS), CDC/NCHS.

42

2008 2009 2010

NOTES: Data are for physician office visits with a principal diagnosis of COPD (ICD-9-CM code 490-492, 496).

0

200

400

600

800

1000

Total <45 45-64 65-74 75+

Rate per 1,000

Age (years)

COPD Physician Office Visits, 2008-2010

SOURCE: National Ambulatory Medical Care Survey (NAMCS), CDC/NCHS.

43

2008 2009 2010

NOTES: Data are for physician office visits made by patients with COPD based on the chronic conditions checkbox or any-listed diagnosis of COPD (ICD-9-CM code 490-492, 496).

Sleeping, Breathing, and Quality of Life: Perspectives from:

National Heart, Lung, and Blood Institute National Institute of Allergy and Infectious Diseases National Institute of Environmental Health Sciences

Gary H. Gibbons, MD, Director National Heart, Lung, and Blood Institute

December 5, 2013

Today’s Research for Tomorrow’s Care: NHLBI Enduring Principles

Investigator-initiated discovery science. Balanced, cross-disciplinary research portfolio. Train a diverse new generation of leaders in science. Implementation science for public health impact

that empowers patients and enables partners. Evidenced-based elimination of health disparities.

Implementation Science

Clinical Trials

Translational Research

Basic Research

Chronic Obstructive Pulmonary Disease (COPD) Research

COPDGene Developing innovative imaging tools to detect COPD

prior to the onset of symptoms. Discovering genetic factors that predispose to COPD as

a guide to new therapies.

SPIROMICS Collaborative teams developing next-generation

diagnostic tests and treatments for COPD.

COPD Clinical Research Network Testing new treatment strategies to reduce

hospitalizations in COPD patients. • Macrolide Antibiotic (Azithromycin) Trial

Long-term Oxygen Treatment Trial (with CMS)

2013

2009

Public Awareness of COPD Learn More Breathe Better Public Health Challenge Estimated 24 million Americans with COPD; yet nearly

50% are undiagnosed and unaware.

NHLBI Public Awareness Campaign (2007) At-Risk Group: Adults 45+ with a history of smoking

Objectives • To increase awareness and understanding of COPD • Empower patients to move from awareness-to-action

Outcomes • Growing 80+ partner network (local/national) in 50 states • Breathe Better Network members conduct COPD

education and outreach in their communities

NAEPP Guidelines Systematically review latest

evidence and identify gaps Provide recommendations

for clinical practice

Healthy People Practice Communities Implement guidelines in clinic and

community settings Define lessons learned, knowledge

gaps & future research priorities

Clinical Research Test new treatment strategies Provide new evidence base

for updating guidelines

Improving Asthma Outcomes by Adherence to Evidence-Based Care

Do preschoolers with recurrent wheeze need inhaled corticosteroids

(ICS) every day? Clinical Trial Evidence: Compared to daily ICS treatment,

intermittent therapy (taken only as needed) uses much less (1/3) medicine for similar benefit

Current Trials Examine New Potential Approaches to Asthma Control:

Is asthma control improved by Vitamin D supplementation? Does treatment with a macrolide antibiotic improve wheezing in

pre-schoolers?

Clinical Research Addresses Critical Questions to Improve Asthma Care

National Heart, Lung, and Blood Institute Epidemiology key risk factors Genetics consortium personalized medicine Basic science cellular, molecular targets Centers to Advance Experimental Therapies Origins of Asthma Projects prevention

National Institute of Allergy and Infectious Diseases

Allergen Epitope Research and Validation Centers Asthma and Allergic Diseases Cooperative Research Centers

role of allergy Inner City Asthma Consortium immune based therapies

National Institute of Environmental Health Sciences

Research (basic science, epidemiology, clinical) understanding environmental exposures and genetic susceptibility for prevention and intervention

Well Being Project understanding respiratory health among children to identify environmental asthma triggers

Broader knowledge of asthma establishing relationship between genes, social factors, and environment

Exposures

Inflammation

STRESS Social

Determinants

Genetics

Developing Novel Therapies for Asthma: A Broad, Balanced, Cross-Disciplinary Portfolio

Recently funded studies show adherence can be improved with novel approaches:

Supervised therapy at school by school nurses Computer assisted learning in urban high schools Voice recognition - automated telecommunication

Current studies examine:

Cultural competency training for primary care physicians Asthma management in Head Start Peer telephone counseling for women of color

Implementation Science Accelerates Adoption of Evidence-Based Care

The National Asthma Education and Prevention Program (NAEPP): From Expert Panel Report-3 to Six Key Actions

www.nhlbi.nih.gov/guidelines/asthma

Six Key Actions to Control Asthma

1. Use inhaled corticosteroids for control of persistent asthma

2. Use written asthma action plans

3. Assess asthma severity

4. Assess and monitor asthma control

5. Schedule follow-up visits

6. Control environmental exposures

The NAEPP’s Guidelines Implementation Panel (GIP) Report (2008) prioritized six key actions

The NAEPP’s Expert Panel Report 3–Guidelines for Diagnosing and Managing Asthma (2007) is based on the best available science

The NAEPP works with over 40 organizations and partners: • Major medical

associations • Voluntary health

organization • Federal partners

Mobilizing Partners to Put Guidelines Into Action for Improved Asthma Control

Purpose: To improve asthma care and control, particularly in hard-hit communities, by promoting awareness and use of the NAEPP clinical practice guidelines

Time Period: 2009-2012

Audiences: Health Care Providers and Organizations Patients, Families, and Caregivers Schools and Childcare Settings States, Communities, and Coalitions

National Asthma Control Initiative (NACI)

Reducing Disparities: Coordinated Federal Action Plan

The Federal Action Plan was developed to avoid redundancies & increase impact through interagency collaborations to: Reduce barriers to asthma care; Enhance local capacity to deliver

care; (e.g., health care teams, healthy homes).

Improve ability to identify children most in need;

Accelerate research efforts to prevent the onset of asthma

PSG

Hypertension risk Obesity risk

Mortality

CVD risk Sleep Deficiency Sleep Disorder

Stroke risk

Sleep and Health Outcomes

Sleep (hours/day)

020406080

<11 11-12 12-13 >13

%

Sleep Duration (h/d)

White Non-white

Sleep and Weight Gain in Children: Racial Disparities

Sleep Duration During Infancy

Short Sleep Duration in Infancy and Risk of Childhood Overweight Taveras et al, Arch Pediatr Adolesc Med. 2008 April; 162(4): 305–311.

CVD/STROKE

Poor Sleep Quality

Shift Work Stress

Depression

Housing Density Crime Noise

Socioeconomic Status

Segregation Racism

Sleep and CVD Disparities: Social Context and Systems Science

Key Takeaways

NHLBI maintains a broad portfolio of research to effectively elucidate factors influencing COPD, asthma and sleep.

Collaborations among NIH Institutes (NHLBI, NIAID, NIEHS) allows us to maximally leverage resources and broaden the NIH scope

We work with our stakeholders to generate evidence, translate the science, increase awareness, and promote partnerships for respiratory and sleep health and attainment of HP 2020 goals.

Vikas Kapil, DO, MPH, FACOEM Acting Deputy Director and Chief Medical Officer

National Center for Environmental Health and Agency for Toxic Substances and Disease Registry

Centers for Disease Control and Prevention

CDC ■ National Center for Environmental Health

(NCEH) • Asthma

■ National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) • Asthma, COPD and Sleep

■ National Institute for Occupational Safety and Health (NIOSH) • Asthma, COPD and Sleep

Sleep and Respiratory Diseases

* Global PROMIS scale I Confidence Interval

Adults Reporting Good or Better Physical and Mental Health* United States, 2010

National Health Interview Survey: United States, 2010

NCEH: America Breathing Easier Since 1999 CDC’s National Asthma Control Program

NCEH: Reducing the Burden from Asthma CDC’s National Asthma Control Program

A Public Health Approach Since 1999:

Surveillance National and state level data Asthma Call-back Survey

Partnerships 34 states, Washington D.C., and Puerto Rico Non-governmental organizations Federal agencies

Interventions and Evaluation Self-management education Health care provider education Environmental management School-based programs

NCEH: National Asthma Surveillance

■ Prevalence

■ Mortality

■ Hospitalization

■ Outpatient visits

■ ED visits

■ Physician office visits

Asthma ED visits and population and risk-based Rates.

NCEH: State Surveillance: Data Profiles

■ Prevalence

■ Mortality

■ Hospitalization

■ Patient education

■ Medication use

NOTES: Data are for adults aged 18 years and over who have ever been diagnosed with asthma and still have asthma, State data from the BRFSS may not be comparable to the national data from the NHIS. SOURCE: Behavioral Risk Factor Surveillance System (BRFSS), CDC/PHSPO

Current Asthma Prevalence, Adults 18+ years

NCEH: Education for a Partnership in Asthma Care

■ Establish and Maintain a Partnership – jointly develop treatment goals – health literacy (read, count, measure, time, schedule) – cultural sensitivity/ ethnic considerations

■ Provider Education – implementing guidelines – communication techniques – clinical decision support – systems-based interventions

Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm p93-164

http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm


NCEH: Education for a Partnership in Asthma Care ■ Asthma Self-Management Education at

Multiple Points of Care – clinic/office-based education – emergency department/ hospital-based education – education by pharmacists – education in school settings – community-based interventions – home-based interventions

■ Tools for Asthma Self-Management – asthma action plans – peak flow meters

Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm p93-164


NCCDPHP: COPD Efforts

■ Develop a strategic framework to tackle COPD as a public health issue

■ Improve COPD surveillance

■ Increase COPD awareness

NCCDPHP: Strategic Framework - COPD

Public Health Strategic Framework for COPD Prevention

NCCDPHP: Improve COPD Surveillance

■ National Health and Nutrition Examination Survey – Adult Medical Condition Questionnaire

– Respiratory Health and Disease Questionnaire

– Spirometry


■ Behavioral Risk Factor Surveillance System – Core question: (Ever

told) you have COPD (chronic obstructive pulmonary disease), emphysema or chronic bronchitis?

– COPD module questions asked of individuals with COPD in 20 states, DC, and Puerto Rico (2011)

NCCDPHP: Increase COPD Awareness

NCCDPHP: Sleep Activities

■ Improve sleep-related content of national and state surveillance systems

■ Increase public awareness of the importance of healthy sleep

■ Support research

■ Promote sleep-healthy policies

NCCDPHP: Improved Surveillance for Sleep Issues

Behavioral Risk Factor Surveillance System:

Days of perceived insufficient rest or sleep question

Percentage of adult population that reported ≥14 days of insufficient rest or sleep in the past

30 days, 2008-2009

■ National Health and Nutrition Examination Survey – Sleep Disorders Questionnaire In 2005-2008 (extensive) In 2009-2010 (limited):

– Actigraphy

■ Youth Risk Behavior Survey – Sleep duration on school nights

■ School Health Policies and Practices Study – School start time


Insufficient Sleep State Fact Sheets


Adults ≥ 18 Years Who Fell Asleep While Driving

in Preceding 30 Days: 2009, 2010



CDC extramural research support ■ BRFSS Sleep Question Validation Study by the University

of Rochester – Wrist Actigraphy – Sleep Journals

■ Delayed School Start Times Study by the University of Minnesota – Academic performance – Student health

NIOSH: Work-Related Asthma (WRA) Burden: ■ About 15% of adult asthma attributable to work ■ About 23% of adults with asthma experience work-related

asthma exacerbations

Examples of NIOSH Efforts: ■ Surveillance (collaboration with national studies, state-

based) ■ Isocyanates (widely used chemicals that cause asthma) ■ Indoor dampness and mold ■ Healthcare (cleaners & disinfectants) ■ Appropriate recognition and treatment of WRA ■ Participation in authoritative groups – Cochrane, American

Thoracic Society, European Respiratory Society, NIH-NAEPP

NIOSH: Work- Related COPD

■ Burden – COPD prevalence, 12 million people; about 15% attributable to work

■ COPD mortality in 2010: 135,000

■ Collaboration with population based-studies is an important source of information – National Health and Nutrition Examination Survey

(NHANES); NIOSH assisted in providing spirometry – Multi-Ethnic Study of Atherosclerosis (MESA); included

spirometry and chest CT; NIOSH is analyzing relationships between occupation, industry, and COPD

■ Studies evaluating specific at-risk populations: coal mine dust, agriculture, construction, WTC dust, etc.

NIOSH: Early Detection of Work-Related COPD Efforts to improve the quality of spirometry: technician training, educational materials Longitudinal spirometry software: monitors spirometry program quality, aids in evaluating individual data, useful for health protection and promotion

NIOSH: Sleep & Work Schedule Research

Burden: Sleep disruption by factors such as rotating shifts is a health hazard. For example, the International Agency for Research on Cancer (IARC) designates shiftwork that involves circadian disruption as probably carcinogenic to humans (Group 2A).

Sleepiness is also a safety issue for those who drive or operate heavy equipment.

NIOSH Efforts ■ developing & testing tailored work schedule & sleep training for managers & workers

in aviation, manufacturing, mining, nursing, retail, & trucking

■ large national survey of long-haul truck drivers includes measures of sleep, fatigue, work hours, health conditions & crashes.

■ surveillance of the prevalence of insufficient sleep by industry sector

■ impact of shift work on women’s reproductive outcomes

■ adverse health outcomes associated with insufficient sleep & shift work in police officers

■ Series of long work hour studies examining insufficient sleep, depression, injury, immune measures

■ quantitative risk assessment of work hours related to occupational illnesses & injury See NIOSH Blog http://blogs.cdc.gov/niosh-science-blog/2012/03/09/sleep/

http://blogs.cdc.gov/niosh-science-blog/2012/03/09/sleep/





EPA’s Asthma Program

■ Aimed at reducing racial and ethnic asthma disparities

Training 5,000+ health care professionals annually to help families manage environmental triggers

Raising awareness and action via the Asthma Media Campaign and www.noattacks.org.

Disseminating best practices and successful strategies through:

o www.AsthmaCommunityNetwork.org o National Environmental Leadership Award in

Asthma Management

http://www.noattacks.org/

http://www.asthmacommunitynetwork.org/

CDC Program Summary

Healthy People objectives related to asthma, COPD, and sleep disorders are addressed by three organizational units at CDC.

CDC has established programs dedicated to improving the quality of life for those affected by respiratory disease and sleep disorders.

The CDC programs work closely with other federal agencies, non-governmental organizations, and state health departments to achieve these objectives.

APPENDIX Note: The information contained within these slides provides additional details to supplement the webinar material.

NCEH: Advancing knowledge on asthma interventions

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President’s task force on Environmental Health risks and afety risks to children.

Coordinated Federal Action Plan to Reduce Racial and Ethnic

Asthma Disparities

Coordinated Federal Action Plan to Reduce Racial and Ethnic

Asthma Disparities

NIOSH: Improve WRA Awareness

■ MMWR

■ Scientific Publications

■ Twitter



■ National Health Interview Survey – Emphysema – Chronic bronchitis – *Chronic obstructive pulmonary disease (COPD)


Tips From Former Smokers Campaign


■ Podcasts

■ Twitter Chat

NCCDPHP: Improved Surveillance

■ Behavioral Risk Factor Surveillance System – Days of perceived insufficient rest or sleep question – Insufficient Sleep module: Usual sleep duration Snoring Excessive daytime sleepiness Falling asleep at the wheel


■ National Health and Nutrition Examination Survey – Sleep Disorders Questionnaire In 2005-2008 (extensive):

• General sleep– sleep duration, sleep latency • Sleep disorders/symptoms – OSA, insomnia, RLS • Sleep-related difficulties

In 2009-2010 (limited): • How much sleep do you usually get at night on weekdays or

workdays? • Have you ever told a doctor or other health professional

that you have trouble sleeping? • Have you ever been told by a doctor or other health

professional that you have a sleep disorder?

– Actigraphy


School Health

■ Youth Risk Behavior Survey – Sleep duration on school nights

■ School Health Policies and Practices Study – School start time

NCCDPHP: Increase Awareness

■ Podcasts

■ Scientific Publications

■ Sleep Essay

Goals 1. To increase public awareness about sleep, sleep

disorders, and the consequences of sleep deprivation 2. To promote science-based public policies 3. To advance basic, clinical, applied, and population-

based research 4. To promote recognition of and access to care for all

individuals with sleep disorders.

NCCDPHP: National Sleep Awareness Roundtable (NSART)

Home-Based Case Management for Asthma

Healthy People 2020 Progress Review December 5, 2013

Karen Meyerson, MSN, APRN, FNP-C, AE-C

Community Asthma Coalition established in 1994

Location: Grand Rapids, Michigan

Population: 82,933 people with asthma in 3 counties

Target population: children (<18 years) with uncontrolled asthma from low-income families

Backgrounds served: 33% African American, 32% Hispanic/Latino, 15% Caucasian 78% covered by Medicaid, 20% uninsured/under-insured

Original funding: Foundations, local hospitals

Who We Are

Garcia, E and Lyon-Callo S. “Asthma Burden for Children in Medicaid.” Epidemiology of Asthma in Michigan. Bureau of Epidemiology, Michigan Department of Community Health, 2012.

Asthma Burden for Children with Medicaid - Michigan

What We Do

Why we are essential to the delivery of quality asthma care in our community: Provide asthma education and case management

support in homes Utilize holistic approach to asthma management

Work with patients, caregivers, families, school staff, health care providers

Serve as the “eyes and ears” of providers in the homes

Tailored Environmental Interventions: Case Management

Staff: Case managers, social worker, community health workers

Home-Based Case Management: Home visits Medical home visit(s) School/daycare visit(s) Up to 18 visits authorized per patient, per year

Community outreach: Speakers’ Bureau

Our Impact The results we’re most proud of: Design and implement a sustainable, comprehensive home-based

asthma case management model First asthma coalition in the nation to partner with a health plan

and obtain reimbursement for services Long-term partnership with health plans who report cost savings

and positive return on investment (ROI) 60% decrease in hospitalizations 40% decrease in ED visits

Two national U.S. EPA awards: “National Model Asthma Program” (2006) National Environmental Leadership Award in Asthma Management (2008)

Getting Early Results: Evaluating the System

Kirk GM, et al. Abstract presented to the American Thoracic Society International Conference in San Francisco - May 2001

MATCH Study: Utilization

28.36%

86.57%

45.45%

5.97%

34.33%

7.58%

0%

20%

40%

60%

80%

100%

≥ 3 ED visit: -78.95 %Δ ≥ 1 ED visit : -60.34 %Δ ≥ 1 Hospitalization: -83.33 %Δ

Percentage of Individuals with Asthma related Medical Care Usage in last 6 months By Intake/Discharge

Intake Discharge

“This is the woman who saved my life”

Key Takeaways Building and Fueling the System

Diversify your funding base

Don’t reinvent the wheel

Plan for focused growth, but ensure financial stability at every step

Build strong community partnerships

“Leave your badges at the door”

Evaluating & Tracking Results

Measure everything and share outcomes with potential funders

The Asthma Network of West Michigan is striving daily to bring asthma under control in our community. Individuals with asthma should expect nothing less.

For more information, please contact:

Karen Meyerson, MSN, APRN, NP-C, AE-C

E-mail: [email protected]

Websites: www.asthmanetworkwm.org

www.GetAsthmaHelp.org

Roundtable Discussion Please take a moment to fill out our brief survey

LHI Infographic Gallery http://www.healthypeople.gov/2020/LHI/infographicGallery.aspx

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Healthy People 2020 objectives in the Food Safety and Medical Products Safety Topic Areas.

Hear from a community-based organization that is partnering to share evidence-based science with

consumers to prevent illness.

To register, visit: www.healthypeople.gov

Healthy People 2020 Progress Review Webinar

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Healthy People 2020 Progress Review Planning Group

■ Jeanne Moorman, CDC/NCEH

■ Joylene John-Sowah, NIH/NHLBI

■ Bill Jirles, NIH/NIEHS

■ Peter Gergen, NIH/NIAID

■ Michael Twery, NIH/NHLBI

■ Antonello Punturieri, NIH/NHLBI

■ Rachael Tracy, NIH/NHLBI

■ Stan Lehman, CDC/NCHHSTP

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■ Rebecca Hines, CDC/NCHS

■ Leda Gurley, CDC/NCHS

■ Kimberly Hurvitz CDC/NCHS

■ Carter Blakey, HHS/ODPHP

■ Emmeline Ochiai, HHS/ODPHP

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■ Yen Luong, HHS/ODPHP

Documents

Sleeping, Breathing, and Quality of Life: A Healthy People ... · Sleeping, Breathing, and Quality of Life: A Healthy People 2020 Progress Review ... Told if asthma is work -related